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Heart transplants (HT) from donors after circulatory death (DCD) have been slowly adopted in the United States. Differences in procurement of DCD organs could increase risk of graft dysfunction due to prolonged ischemia after withdrawal of life-support and agonal time. Two methods exist for DCD heart procurement: an ex vivo perfusion system (TransMedics Organ Care System [OCS]) and normothermic regional perfusion (NRP) with extracorporeal membrane oxygenation. The differences of each procurement method could be responsible for abnormal hemodynamic indices. We sought to compare hemodynamic parameters in HT from donor after brain death (DBD) vs DCS and OCS vs NRP donors. Single-center, retrospective study of all HT performed at our institution beginning the year of our first DCD HT. We divided our cohort by DBD and DCD transplants. In addition, we compared the two methods of DCD procurement, OCS and NRP. Measurements from protocolized, routine right heart catheterizations (RHC) at 10 to 14 days post-transplant were used for this analysis. A total of 226 HT from 01/2020 to 9/2022 were included, 154 (68.1%) DBD and 72 (31.9%) DCD HT. Within the DCD cohort, 16 (22%) were procured by OCS and 56 (78%) by NRP. The RHC was performed at a mean of 10.8 days (SD 2.3). When comparing DBD to DCD, the only significant difference was mean pulmonary artery pressure. (Table 1) No statistically significant differences in hemodynamics were observed between the two methods of DCD procurement (Table 2). Hemodynamic indices were similar between DCD and DBD HT recipients when measured around day 10 post-transplant. In particular, there were no differences in the parameters of RV dysfunction. Similarly, no differences were observed when comparing types of DCD procurement, OCS and NRP. These findings suggest that graft quality should be considered equal regardless of the type of donor or method of procurement. [ABSTRACT FROM AUTHOR]

Right ventricular (RV) dysfunction is common following heart transplantation and often multifactorial in etiology. It is unclear if the development of RV dysfunction early after transplant is predictive of worse outcomes. Pulmonary arterial pulsatility index (PAPi) is a marker of RV dysfunction shown to predict outcomes in left ventricular assist device patients. To our knowledge, PAPi has not been studied in heart transplantation. We investigated whether PAPi is associated with unfavorable outcomes post heart transplant. Single-center, retrospective study of heart transplants performed at our institution from January 2020 to September 2022. We divided our cohort into two groups based on PAPi ≤ or > 1.63 (lowest quartile cutoff). The hemodynamic parameters to calculate PAPi [(pulmonary artery systolic pressure-diastolic pulmonary artery)/right atrial pressure] were obtained from a right heart catheterization (RHC) performed between days 10 and 14. Using T-test, Mann-Whitney-U and Fisher's exact test as appropriate, the groups were compared with regards to baseline characteristics and outcomes. Multivariable logistic regression was used to adjust for confounders. A total of 226 patients underwent heart transplant from 01/2020 to 9/2022. From those, 204 had data on RHC. The RHC was performed at a mean of 10.8 days (±2.3). PAPi was > 1.63 in 154 patients (75.5%) and 50 (24.5%) had a PAPi ≤ 1.63. Baseline characteristics were similar among the two groups. Among patients with PAPi <1.63, we found a significant difference in days requiring inotropes and length of stay in the intensive care unit (ICU) and the association remained significant after adjusting for confounders in multivariable analysis (Table 1). Early right ventricular dysfunction post heart transplant as measured by PAPi was associated with longer need for inotropes and length of stay in ICU. Further research is warranted to determine long-term implications of a low PAPi. [ABSTRACT FROM AUTHOR]

Objective: Blood-based biomarkers provide a crucial information in the progress of neurodegenerative diseases with a minimally invasive sampling method. Validated blood-based biomarker application in people with amyotrophic lateral sclerosis would derive numerous benefits. Canine degenerative myelopathy is a naturally occurring animal disease model to study the biology of human amyotrophic lateral sclerosis. Serum derived exosomes are potential carriers for cell-specific cargoes making them ideal venue to study biomarkers for a variety of diseases and biological processes. This study assessed the exosomal proteins that may be assigned as surrogate biomarker that may reflect biochemical changes in the central nervous system., Methods: Exosomes were isolated from canine serum using commercial exosome isolation reagents. Exosomes target proteins contents were analyzed by the Western blotting method., Results: The profiles of potential biomarker candidates in spinal cord homogenate and that of serum-derived exosomes were found elevated in dogs with degenerative myelopathy as compared to control subjects., Conclusions: Serum-derived exosomal biomolecules can serve as surrogate biomarkers in neurodegenerative diseases.KEY MESSAGESA canine with degenerative myelopathy can serve as a model animal to study human amyotrophic lateral sclerosis.Serum-derived exosomes contain Transactive Response DNA Binding Protein 43 (TDP-43), a potential biomarker candidate.The levels of spinal cord TDP-43 proteins and that of serum-derived exosomes exhibited similar profiling. Therefore, serum derived exosomes may be used as a venue for establishing blood-based biomarkers for neurodegenerative diseases.

Objective: Previous studies of the natural history of abdominal aortic aneurysms (AAAs) have been limited by small cohort sizes or heterogeneous analyses of pooled data. By quickly and efficiently extracting imaging data from the health records, natural language processing (NLP) has the potential to substantially improve how we study and care for patients with AAAs. The aim of the present study was to test the ability of an NLP tool to accurately identify the presence or absence of AAAs and detect the maximal abdominal aortic diameter in a large dataset of imaging study reports., Methods: Relevant imaging study reports (n = 230,660) from 2003 to 2017 were obtained for 32,778 patients followed up in a prospective aneurysm surveillance registry within a large, diverse, integrated healthcare system. A commercially available NLP algorithm was used to assess the presence of AAAs, confirm the absence of AAAs, and extract the maximal diameter of the abdominal aorta, if stated. A blinded expert manual review of 18,000 randomly selected imaging reports was used as the reference standard. The positive predictive value (PPV or precision), sensitivity (recall), and the kappa statistics were calculated., Results: Of the randomly selected 18,000 studies that underwent expert manual review, 48.7% were positive for AAAs. In confirming the presence of an AAA, the interrater reliability of the NLP compared with the expert review showed a kappa value of 0.84 (95% confidence interval [CI], 0.83-0.85), with a PPV of 95% and sensitivity of 88.5%. The NLP algorithm showed similar results for confirming the absence of an AAA, with a kappa of 0.79 (95% CI, 0.799-0.80), PPV of 77.7%, and sensitivity of 91.9%. The kappa, PPV, and sensitivity of the NLP for correctly identifying the maximal aortic diameter was 0.88 (95% CI, 0.87-0.89), 88.8%, and 88.2% respectively., Conclusions: The use of NLP software can accurately analyze large volumes of radiology report data to detect AAA disease and assemble a contemporary aortic diameter-based cohort of patients for longitudinal analysis to guide surveillance, medical management, and operative decision making. It can also potentially be used to identify from the electronic medical records pre- and postoperative AAA patients "lost to follow-up," leverage human resources engaged in the ongoing surveillance of patients with AAAs, and facilitate the construction and implementation of AAA screening programs., (Copyright © 2021 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)

Venovenous (V-V) extracorporeal membrane oxygenation (ECMO) is used for respiratory failure that is suspected to be reversible (bridge to recovery), or as a bridge to lung transplantation. Patients with proximal airway obstruction due to endobronchial malignancy can develop acute respiratory failure, and may benefit from V-V ECMO as a bridge to airway intervention, further treatment, and eventual recovery. We describe a case of a superior sulcus tumor with tracheobronchial and superior vena cava invasion causing both respiratory failure and superior vena cava syndrome. This was treated successfully with V-V ECMO, bronchial stenting, and radiotherapy., (Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Venous thromboembolism is the third leading cause of cardiovascular death in the United States and is the second leading cause of death among hospitalized cancer patients. Continued controversy exists regarding the role of thrombolytic therapy among patients with acute pulmonary embolism. Limited research exists on thrombolytic therapy in this setting, most of which has focused on symptoms, including right ventricular function, hemodynamic status, and electrocardiographic changes. However, these studies have excluded patients with a known malignancy. Presented is an interesting case of a patient, in remission from breast cancer, who presented to the emergency department with symptomatic pulmonary emboli. The presentation, medical management, and consequences of the treatment have been discussed. Also, a brief review of the literature is presented regarding the treatment of acute pulmonary embolism.

The transport of critically ill patients is challenging for nurses and patients alike. It is imperative that patient safety be the primary focus. The use of a specialized transport team can help to alleviate many of the adverse effects of the transport.